OASIS Alert

Hint: These questions address different aspects of behavior problems.

Misunderstanding behavior problem questions can cost you hundreds of dollars, outcome success and risk adjustment accuracy.

Many clinicians report finding M0610 and M0620 two of the most confusing questions on the OASIS assessment. And the three severity points at stake in M0610 are only part of the reason to improve accuracy.

What these M0 questions ask: M0610 (Behaviors demonstrated at least once a week) questions whether the patient is experiencing at least weekly specific behaviors: memory deficits; impaired decision-making; verbal disruption; physical aggression; non-verbal disruptive, infantile or socially inappropriate behavior; or delusional, hallucinatory or paranoid behavior.

M0620 (Frequency of behavior problems [reported or observed]) questions the frequency of behavior problems and lists only a selection of possible problems (wandering episodes, self abuse, verbal disruption, physical aggression, etc.). The available answers to M0620 are never, less than once a month, once a month, several times each month, several times a week and at least daily.

Tip: The question leaves it up to the clinician to decide what is included in "etc."


Follow This Expert Advice

Behavior problems can make care plan compliance difficult and negatively affect your outcomes. But with these expert tips you'll get the answers right every time:

--Look at and score each question separately. Each question has its own rules and specific instructions, says Linda Krulish, principal of OASIS Answers in Redmond, WA.

Example: In M0620, "'Behavior problems' are not limited to those identified in M0610," the Centers for Medicare & Medi-caid Services specifically instructs in the M0620 definition.

Understand the reason behind the question. M0610 looks for clues to altered cognitive or neuro/emotional status, CMS says in the question definition. On the other hand, M0620 is looking for behaviors that lead to concern for the patient's safety and social environment, CMS explains.

Some behaviors you might list in M0610 may not be considered safety issues in M0620, Krulish explains. And the patient may demonstrate none of the behaviors listed in M0610 but still have some other behavior problem -- such as wandering -- several times a day in M0620.

Lesson learned: Don't base your an-swer to M0620 on what you answered in M0610 -- or vice versa, experts agree.

--Learn how to elicit accurate answers. Patients and families often are reluctant to admit to behavior problems, so you may need your Sherlock Holmes hat to answer these questions accurately.

Use some examples when you interview caregivers, suggests the expert panel from the Fazzi-3M OASIS Integrity Project.

Strategies: Try to interview caregivers and patients separately because each may be reluctant to discuss these problems in the presence of the other, experts say. And if the patient is exhibiting multiple behavior problems, an-swer M0620 based on the total frequency of all the behaviors, the expert panel advises.